992 (44 USC 210% Note). Caset:Niw
D3- 14-20)

JFK ASSASSINATION SYSTEM
IDENTIFICATION FORM

Date

01/20/98
Page 1

AGENCY

RECORD NUMBER
RECORDS. SERIES
AGENCY FILE NUMBER

AGENCY INFORMATION

INSCOM/CSF
194-10004-10139

DOD-AFFILIATED PERSONNEL INCIDENT INVESTIGATIONS

PAGE 372-373

ORIGINATOR
FROM

TO

TITLE

DATE

PAGES
SUBJECTS

DOCUMENT TYPE
CLASSIFICATION
RESTRICTIONS
CURRENT STATUS

DATE OF LAST REVIEW
OPENING CRITERIA
COMMENTS

DOCUMENT INFORMATION

USA

HAYASHIDA, MYRON K.
USA INTELLIGENCE CMD
[ RESTRICTED ]
11/25/66

2

FROMER, DAVID R.

INDUCTION

PAPER, TEXTUAL DOCUMENT
UNCLASSIFIED

3

RELEASED WITH DELETIONS
03/07/95

RECORD REGRADED UNCLASSIFIED ON 2 SEP 94.

NOT INCLUDED.

INCLOSURES

NW 88643 _Docid:34528580. Page 4_..__.------.----------------------- eee eee eee eee ---

REQUEST FOR AND RESUL 1S OF PE

AR 381-130) WUT
THRU:

ALACTION * 25 November 1966

TO: (Contro! Office) FROM: (Requesting Agency)

CG, USA Intelligence Cmd CG, USAREC \ NT CO, AFEES

ATTN: ACofS, CONOPS ATTN: Secu pity OFgdcer 1515 Clay Street
PO Box 398 Hampton, Va 23365 9 DE \@fkland, California

Fort Holabird, fid 21219

(Enter name and address of the ACTION AGENCY to which results are to be

requester)

-
CHIEF, USAPSG
ATTN: Adjudication Branch
Fort Holabird, Md 21219

L

1, SUBJECT (Last name in capitals, first and 2. ALIAS(ES),
middie names)
FROMER, Dawid Reed None

[4. DATE OF BIRTH
(Day, Month, Year)

21 July 1942

7. REQUESTED ACTION
8. TYPE OF INVESTIGATION:
Cynac [(jnaci [Jet [OTHER (Explain in Item 15)
10. TO DETERMINE SUITABILITY FOR:

INDUCTION

Chicago, Illinois

(VALIDATION

DX] INVESTIGATION

11. JUSTIFICATION

PAR 18, AR- 604-10

12. REVIEW OF FILES REQUIRED BY PARAGRAPH
([) No UNFAVORABLE INFORMATION

CONTEMPLATED

13, LATEST INVESTIGATION/ CLEARANCE (Type, when, by whom)

A

5. PLACE OF BIRTH (City, State and country)

3.

b. | | FOR LIMITED ACCESS AUTHORIZATION

INFORMA TION SUMMARIZED IN ITEM 15 “-

sent, if known by

CONTROL OFFICE USE ONLY

REQUIREMENT REQUEST NO.

DOSSIER NO. OPENING DATE

REMARKS

=

SECTION | — REQUESTER TO CONTROL OFFICE
Fetaistalataretytal

564-58-8137

6. GRADE AND POSITION

N/A

[-] RECORDS CHECK
@.FOR CLEARANCE AND/OR ACCESS TO:
top secret ([_|secret [_] CONFIDENTIAL

c. (J INTERIM CLEARANCE DESIRED
d. (RXOTHER (Explain in Item 15)

AR 604-5, COMPLETED ON
UNFAVORASLE INFORMATION DETERMINED NOT TO BE A BAR TO ACTIUN

REVEALED:

14. NO BREAK IN FEDERAL SERVICE
EXCEEDING SIX MONTHS SINCE

15. REMARKS (If unfavorable information entered, transmit in sealed envelope thru intelligence channels, ),

Request investigation of regiatrant in view of remarks edde by registrant in remarks

section afbeDR- Form 98) ad bo form 398. SS JU! F-Y2-¥2- 20¥

Headeuin toes
US Army Recruiting Commant
Hampton,, Virginia 2836°

‘ : ata st vivs
eye mn 7 vas ae VUMabLS
nv Gn eb ab gion"
INCLS TYPED NAME AND TITL
MYRON Ko HAVAgHIDA
2 1/LT, AGC

SECTION fl - CONTROL OFFICE TO REQUESTER

SIGNATURE

372. j loyal...

DATE

| nia

16. [_] NEW FINGERPRINT CARD REQUIRED

() 'tems

CI INTERIM REPORT FORWARDED. REQUEST REPORT OF ACTION TAKEN AND RETURN OF INCLOSURES UPON COMPLETION,

ON SPH (PSQ) REQUIRE CORRECTION AND/OR COMPLETION.

SIGNATURE

INCLS TYPED NAME ANO TITLE ~

a
D A FORM

1 APR 64

2784

NW 60613 Docid:34528500 Page 2

H SECTION tll = REQUE. RK POUU 5 S " a
17, REPORT OF ACTION

{[] INFORMATION NOTED (7) suBJeEcT RE; [CT] INFORMATION CONSIDERED NO BAR TO
weit : 4
SENSITIVE oy l usvidricA tion CLEARANCE. REQUEST COMPLETION
_ .
MAY BE CANCELED.™ OF INVESTIGATION.

18. SUBJECT WAS TRANSFERRED

HEADQUARTERS

REMARKS (If retuming corrected forms, state here)

FYPED NAME AND TITLE- SIGNATURE

SECTION IV — CONTROL OFFICE TO ACTION AGENCY
20. RESULTS OF PERSONNEL SECURITY ACTION

CI No RECORD ([] FAVORABLE (CJ Minor UNFAVORABLE INFORMATION RECORDED IN ITEM 21
CO PRIOR INVESTIGATION INSUFFICIENT FOR ACTION CONTEMPLATED &) FORWARDED FOR SECURITY OETER=
UF NEEDED, INITIATE REQUEST FOR INVESTIGATION. MINATION BY CLEARING AUTHORITY
TYPE OF INVESTIGATION COMPLETED SY DOSSIER NUMBER

(jnac (-) NaCI Oe XJ oTHeR USAINTC te PO Mar 1967 AA BL ho 20

21. REMARKS

a. THIS FORM, TOGETHER WITH ANY INCLOSURES, REPORT OF ACTION TAKEN AND USACRF COPY OF DA FORM 873
(if appropriate) WILL BE RETURNED TO THE CONTROL OFFICE WITHIN DAYS AFTER RECEIPT.
IN THE EVENT SUBJECT HAS BEEN TRANSFERRED FROM YOUR COMMAND, THIS FORM AND INCLOSURES WILL BE
RETURNED IMMEDIATELY WITH ITEM 23 COMPLETED.
ATTENTION IS INVITED TO: PARAGRAPHS AR 604-5; PARAGRAPH ___AR 604-11; PARAGRAPH ___
AR 640-498; AND PARAGRAPH AR 381-130, AS APPLICABLE. :

inets SUBJECTIS Dosg— |] TY Pep Name AND TITLE DAN H., DIETRICH SIGNATURE
sier and that of HIS  Y Lt Col

father - D8 03 23 84 Gri

iS

22. REPORT OF ACTION x

aoe : RESCINDED PER DA MESSAGE
(C) FAVORABLE DETERMINATION, USACRE ((] UNFAVORABLE CETERMINATION, (pik FB5375; TATED 16 MAY 56,

COPY DA FORM 873 ATTACHED “  RECOMMENOED ACTION IN ITEM 24 GATION ASINDICATEDO IN !TEM 24

23. SUBJECT WAS TRANSFERRED

To HEADQUARTERS agra 4
Mtoe

1 24. REMARKS

3 /eBoe geeesca th © daa - Phas voy. setive
° Maghises is Baslvtod Free su boua FG
. Yerwsnatvion™ .

‘ MP Sal 2 bo Oy . -
i . toon: seg gh ite :
. ; vad ake MB.

INCLS TYPBED NAME AND TITLE SIGNATURE

NW 60613 Docid:34528500 Page 3

